VTQ与APRI诊断慢性乙型病毒性肝炎合并非酒精性脂肪肝肝纤维化的价值

Study of virtual touch tissue quantification and aspartate aminotransferase to platelet ratio for hepatic fibrosis in patients with Chronic Hepatitis B combined with nonalcoholic fatty liver

目的比较声触诊组织量化(virtual touch tissue quantification,VTQ)与天门冬氨酸氨基转移酶/血小板比值(aspartate aminotransferase to platelet ratio index,APRI)对慢性病毒性乙型肝炎合并非酒精性脂肪肝(non-alcoholic fatty liver,NAFL)肝纤维化的诊断价值。方法选取2012年5月至2015年5月深圳市第三人民医院收治的116例慢乙肝患者,按病理结果分为肝纤维化组(肝纤组)、肝纤维化合并NAFL组(合并NAFL组),测量患者肝脏VTQ值及APRI。39例健康志愿者作为对照组,同法测量所有指标。结果三组在性别、年龄、BMI、软组织厚度、肝右叶斜径(ODRL)、脾厚、APRI均存在统计学差异(P<0.05),单因素方差分析VTQ值,三组间两两比较差异均有统计学意义(P<0.05);采用协方差分析校正后,对照组与合并NAFL组间VTQ值无统计学差异(P>0.05)。不同肝纤维化病理分期,VTQ值及APRI差异有统计学意义(P<0.001)。二者与病理相关系数分别为0.721、0.618。结论慢乙肝肝纤维化不合并NAFL时,VTQ比APRI能更有效反映肝纤维化程度,与病理结果相关性更好,但当二者合并时,VTQ无法真实反映肝纤维化的存在,APRI则仍可较好的反映出肝纤维化的存在。

Objective To compare the diagnostic value of virtual touch tissue quantification(VTQ)and aspartate aminotransferase to platelet ratio index(APRI)for noninvasive assessment of hepatic fibrosis in patients with Chronic Hepatitis B combined with non-alcoholic fatty liver(NAFL)Method One hundred and sixteen patients with HBV infection were recruited from May 2012 to May 2015 in our hospital.They were divided into the hepatic fibrosis group and hepatic fibrosis combined with NAFL group according to the pathological results,and all subjects were examined by VTQ and APRI systems.In addition,sex,age,and etc were also included as covariates.39 healthy volunteers were selected as the control group,who accepted the same examinations.Results For the three groups results,there were statistical differences(P<0.05)in sex,age,BMI,thickness of soft tissue,oblique diameter of right lobe of liver(ODRL),thickness of spleen and APRI.The statistical difference of VTQ were significant(P<0.05)among these three groups by one-way analysis of variance(ANOVA),but there was no statistical difference in VTQ between the control group and the hepatic fibrosis combined with NAFL group(P>0.05)by covariance analysis correction.The difference of VTQ value and APRI between different pathological stages of hepatic fibrosis was statistically significant(P<0.001),with the correlation coefficients of 0.721 and 0.618 respectively.Conclusions Compared with APRI,VTQ is more accurate to evaluate hepatic fibrosis in patients without NAFL.VTQ provides better correlation with the pathological results,but when hepatic fibrosis combined with NAFL,VTQ can't truly reflect the presence of hepatic fibrosis.APRI is a better indicator in this situation.